Provider Demographics
NPI:1215076625
Name:MUTKA, VALERIE-LYNN ANAWALD (LCSW-R)
Entity type:Individual
Prefix:
First Name:VALERIE-LYNN
Middle Name:ANAWALD
Last Name:MUTKA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-0057
Mailing Address - Country:US
Mailing Address - Phone:585-813-4075
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 57
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036-0057
Practice Address - Country:US
Practice Address - Phone:585-813-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR077841-11041C0700X
NY068311-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical